Outline of Problem
Galenical external preparations are referred to creams and lotions unavailable commercially. In Hospital Sungai Bakap, 67.5% of galenical preparations were detected with errors in preparation name, raw material, expiry date, packaging size, strength and batch number. These will lead to medication error, wastage and reduce efficacy.

Key Measure for Improvement
The objective is to reduce the incidence of error in the preparation to 0%.

Process of Gathering Information
A cross-sectional study was conducted using universal sampling in March 2017 till Feb 2019 with samples more than 400 for each phase (verification study, pre-remedial, cycle-1 and cycle-2). Data collection was done using the worksheet checklists and label checklists to all external preparations.

Analysis and Interpretation
Pre-intervention study detected errors in pre-packing size (66.2%), expiry date (15.2%), strength of the preparation (3.7%) and batch number (1.9%) respectively. ABNA was 66.2%. These errors were due to inexperienced personnel, poor technique, no counter-checking, incomplete data on label and look alike sound alike. Products worth RM 197.71 were discarded due to errors and 2 hours was required to redo preparations with errors.

Strategies for Change
A checklist for worksheet and label for galenical preparations was generated and implemented. ‘Look Alike Sound Alike’ raw materials were tagged to increase alertness among pharmacy staffs. Peer reviews were carried out to ensure the personnel’s competency and standards were maintained. A booklet entitled ‘Description of Appearance of Galenical Preparation’ was prepared as reference. Memo on adherence to the Standard Procedure was created and posters were placed at the workplace set as reminders to all the staffs. Orientation and briefing was given to all new personnel in Galenical Unit. The format of the label had been standardized.

Effects of Change
The percentage of errors detected were reduced in pre-packing size (pre-remedial= 66.2%, cycle-1= 19%, cycle-2= 9%), expiry date of preparation (pre-remedial= 15.2%, cycle-1= 10.2%, cycle-2= 0%), strength of preparation (pre-remedial= 3.7%, cycle-1 and cycle-2= 0%) and batch number (pre=remedial=1.9%, cycle-1=0.6%, cycle-2=0%). ABNA successfully improved from 66.2% (pre-remedial) to 19% (cycle-1) and 9% (cycle-2). No preparations to be reproduced as error occurred on label involved cost of new labels.

The Next Step
We aim to fully utilize the booklet ‘Description of Appearance on Galenical Preparations in HSB’, diversify the information to comprehensive protocol and to implement in internal preparations. This booklet will be distributed to the health clinics for reference upon checking on the products received and kept in their settings. We would like to share our remedial actions and experiences with other hospitals.